Transcript Highlights:

• care provider who understands what access to care truly means for...” “...frontline health care provider
• From a health care perspective, this funding helps ensure continuity of care, protects emergency response
• capability, and supports the health care workforce that serves...” “...this region.
• I believe that that is really what we would consider rural health care.
• But I don't think we need this at this... ...you know, in furthering rural health care.

Bills: HB1623

Keywords: HB 1623, North Dakota, rural health, rural health transformation program, medical facility infrastructure loan fund, medical facility infrastructure loan program, rural health loan program, Bank of North Dakota, Department of Health and Human Services, HHS, federal grant, health care infrastructure, rural hospitals, critical access hospitals, nonprofit health care providers, gap financing, loan fund, public health funding, healthcare financing, Medicaid

Summary: The committee first heard House Bill 1624, the “Universal Lunch Bill,” from Rep. Mike Nathie. He argued the proposal should be placed in Century Code rather than the Constitution so future legislatures can adjust it if state finances tighten, and said the bill would start the program a year earlier with a $65 million appropriation for one school year. DPI testified that the estimate did not include nonpublic schools that do not participate, and members questioned the impact on Title I, free-and-reduced applications, private-school accountability, breakfast mandates for schools that do not currently serve breakfast, and whether the funding could come from the DPI budget or other sources. Supporters, including North Dakota United, the North Dakota Catholic Conference, a pediatrician, and the American Heart Association, said universal meals improve student health and learning, reduce family costs, and are better handled in statute than by constitutional amendment. No opposition testimony was offered, and the chair closed the hearing for later work-session action. The committee then took up House Bill 1627, introduced by Rep. Tye Dressler, which would raise the income threshold for the state-funded school lunch program from 225% to 300% of poverty, with an estimated cost of about $7 million for 2026-27. Dressler said the bill is intended as a targeted, budget-friendly alternative to the ballot measure and emphasized that the state should maximize federal meal dollars while improving participation in the current program. Members questioned whether raising the threshold would actually increase utilization, whether a dollar amount would be clearer than a percentage, and how the change would affect federal reimbursements and application rates. DPI said it could quickly calculate additional percentage levels, and the chair closed the hearing, directing DPI to prepare more numbers for the work session. Finally, the committee opened Senate Bill 2403, presented by Sen. Schiable, to create a short-term bridge-loan program for financially distressed hospitals, centered on Jacobson Memorial Hospital in Elgin. The bill would authorize up to $5 million per loan, with a $10 million appropriation available on a first-come, first-served basis, and would run only through June 30, 2027. Schiable said the hospital’s debt and operating problems threaten local health care, ambulance service, and the community’s economy, and that the proposal was designed narrowly with Bank of North Dakota review to avoid creating a broad precedent. Committee members asked whether the appropriation could be reduced and whether the bank would still apply commercial feasibility and repayment standards; Schiable said yes, the bank would still evaluate the loan and could reject it if it was not sound.

Transcript Highlights:

• health care provider, school, Would like every health care, rural health care provider, school, public
• A lot of the health care providers helped us put this application together, so it was practical, and
• You can literally change what a rural health care facility can provide by one estate gift—one.
• care facility to be providing better care.
• Not that we're looking at it, I'm talking about the health care provider themselves.

Bills: HB1623

Keywords: HB 1623, North Dakota, rural health, rural health transformation program, medical facility infrastructure loan fund, medical facility infrastructure loan program, rural health loan program, Bank of North Dakota, Department of Health and Human Services, HHS, federal grant, health care infrastructure, rural hospitals, critical access hospitals, nonprofit health care providers, gap financing, loan fund, public health funding, healthcare financing, Medicaid

Summary: The committee heard House Bill 1623, the appropriations bill tied to North Dakota’s Rural Health Transformation Program, which is funded through a new federal rural health care grant. Senator Bekkedahl explained the bill’s background, the interim committee process that developed it, and the federal conditions attached to the award, including spending deadlines, administrative cost limits, and restrictions on uses such as new construction, supplanting existing funding, and certain other costs. Legislative staff then walked through the seven sections of the bill, including appropriation authority, transfer authority, contingent appropriations for pass-through grants, procurement and public improvement exemptions, recipient reporting, legislative reporting, and immediate effective date. Commissioner Traynor and HHS staff described how the department plans to implement the program, emphasizing that the funding is intended to improve rural access, workforce recruitment and retention, technology and data connectivity, and community health initiatives. They said the department will rely on local applications, technical assistance, templates, listening sessions, and partnerships with providers, schools, public health units, tribal entities, and other community groups. Members asked about reimbursement timing, upfront costs, administrative expenses, sustainability after the five-year grant period, and whether CTE centers, public health units, gyms, grocery stores, and other community partners could participate; the department said yes, within program rules and with a focus on measurable outcomes and sustainability. Several supporters testified in favor. Mental Health America of North Dakota and the Mental Health Advocacy Network supported the bill and urged investment in community-based mental health, crisis response, children’s services, peer support, and mobile crisis teams. HIA Health described the grant as a chance to expand home-based and hospice care, noting that rural providers already have workable models but need funding to scale them. A cybersecurity representative also supported the bill, warning that the large amount of health data and AI-related tools will require strong data protection and professional support. The hearing was closed with no opposition testimony, and the committee announced it would return later in the day for further work on the bill and other measures.

Transcript Highlights:

• Postpartum depression is a mental health...
• Postpartum depression is a mental health disorder that is damaging to the mother's health.
• Untreated postpartum depression increases long-term health care costs due to emergency interventions
• and long-term mental health needs, as well as... ...long-term mental health needs, as well as the damaging
• Is there a funding mechanism for ADPH to take care of the cost?

Bills: HB330, HB336, HB322, HB346

Keywords: lead ban, plumbing codes, lead-free, public health, environmental management, respiratory therapy, interstate compact, licensing, military service members, healthcare access, regulation, postpartum depression, postnatal care, maternal mental health, perinatal depression, postpartum screening, new mother, birth mother, newborn discharge, hospital discharge materials

Bills: SB 95, SB 268, SB 493, SB 619, SB 660, SB 922, SB 984, SB 1098, SB 1188, SB 1307, SB 1332, SB 1822

Keywords: immunization, written informed consent, civil liability, health care provider, vaccine compensation, administrative penalty, health care, licensing, complaint procedure, disciplinary action, law enforcement, conscience protection, health care services, civil remedy, health care providers, patient access, hospital safety, emergency room, bollards, traffic protection

Transcript Highlights:

• We're working on dementia care navigation training and dementia awareness, early signs of Alzheimer's
• We're looking at evidence-based brain health and risk reduction activities statewide.
• These are being promoted on the ADHS website and in all local public health programs, something that
• We're working on dementia care navigation training and dementia awareness, early signs of Alzheimer's
• We're looking at evidence-based brain health and risk reduction activities statewide.

Bills: SB1131, SB1249

Keywords: cardiac arrest, defibrillators, school safety, emergency response, CPR training, Arizona education funding, Alzheimer's, dementia, memory care, cognitive decline, brain health, caregiver support, long-term care, in-home care, public health, health services, state plan, dementia services program, Arizona Department of Health Services, aging

Summary: The Committee on Appropriations heard two bills. Senate Bill 1131 would require school districts and charter schools to report AED counts, CPR/AED training levels, and cardiac emergency response plans to ADE, and would appropriate $1 million for AED purchases and maintenance. The committee adopted an amendment shifting the funding source from the general fund to the industry-recognized certification and licensure reimbursement fund, after staff said the fund had an estimated $2 million balance and continued to receive $1 million annually. The American Heart Association testified in support, emphasizing the need for AEDs, CPR training, and emergency planning in schools. The bill was returned with a due pass recommendation by a 15-1 vote, with two members voting present and several members noting concerns about using the special fund rather than general funds. Senate Bill 1249 would create or continue a dementia services program and Alzheimer’s state plan at the Department of Health Services and appropriate $600,000 from the Health Services Lottery Moneys Fund. The Alzheimer’s Association testified in strong support, saying the prior three-year appropriation helped establish the plan and workgroups and that the new funding would support implementation, caregiver support, data collection, training, and grant applications. Several members raised concerns about taking money from a fund that supports maternal and child health programs such as Health Start and WIC, describing it as “robbing Peter to pay Paul,” while others said they supported the policy but wanted a sustainable funding source. The bill received a due pass recommendation on a 9-3 vote, with three members voting present.

Transcript Highlights:

• overall health care costs.
• your strategy to provide that care? your strategy to provide that care?
• deliver health care.
• deliver health care.
• deliver health care.

Bills: HB0143, HB0129

Keywords: health care providers, free speech, discrimination, governmental agencies, civil remedies, physician access, internationally trained physicians, medical licensing, provisional license, healthcare workforce, 916, all

Transcript Highlights:

• Uh, committee, I will now move House Bill 143, Free Speech for Health Care Providers.
• Uh, committee, I will now move House Bill 143, Free Speech for Health Care Providers.
• I will now move House Bill 143, Free Speech for Health Care Providers.
• health care professionals. health care professionals.
• care providers.

Bills: HB0143, HB0129

Keywords: health care providers, free speech, discrimination, governmental agencies, civil remedies, physician access, internationally trained physicians, medical licensing, provisional license, healthcare workforce, 916, all

Transcript Highlights:

• If they're a nongovernmental entity and they're a nonprofit and they meet with a department and provide
• Provider associations—we have a ton of health care provider associations, from hospitals to behavioral
• I feel like if these nonprofits, when it comes to that, are taking care of these adults and children
• I feel like that if these nonprofits when it comes to that are taking care of these adults and children
• duties and responsibilities of the Louisiana Department of Health; to provide for reporting; and to

Bills: HR290, HR298, SB405, SCR61, HR318

Keywords: gender-affirming care, gender affirming therapy, gender-affirming hormone therapy, transgender health, trans youth, LGBTQ, mental health, psychosis, psychiatric conditions, puberty blockers, androgen blockers, cross-sex hormones, estrogen, testosterone, informed consent, screening, monitoring protocols, Louisiana Department of Health, LDH, House Health and Welfare

Transcript Highlights:

• purposes of health care research. purposes of health care research.
• <01:21:07.840> care the investments that our health care the investments that our health care
• I've been caught up in these. 99.9% of the time if they must pay the $3, the health care provider gets
• I've been caught up in these. 99.9% of the time if they must pay the $3, the health care provider gets
• I've been caught up in these. 99.9% of the time if they must pay the $3, the health care provider gets

Bills: HF4401, HF4466

Keywords: HF4401, Minnesota Medical Assistance, dental reimbursement, dental rates, critical access dental providers, Medicaid dental, MinnesotaCare, managed care plans, county-based purchasing plans, fee-for-service, oral health access, safety-net clinics, federally qualified health centers, rural health clinics, Indian health services, state-operated dental clinics, low-income patients, children's dental care, provider reimbursement, dental access

Transcript Highlights:

• The Link is a youth- and adult-led nonprofit based in North Minneapolis that provides street outreach
• <00:49:59.040> mental<00:49:59.320> health staff on to provide mental health staff
• on to provide mental health services<00:50:00.040> in-house.
• federally designated as mental health federally designated as mental health provider<01:06:00.720
• behavioral health providers grow by 49%. behavioral health providers grow by 49%.

Bills: HF1767, HF2068, HF4725, HF4637, HF4638

Keywords: human services, community support, integrated care, disability services, stakeholder consultation, homeless youth, grants, funding, Minnesota, mental health, substance use disorder, education, workforce development, licensure, direct care services, healthcare, long-term care, personal care assistants, employment support, medical assistance

Summary: The Human Services Finance and Policy Committee approved the April 8, 2026 minutes and then heard House File 1767, as amended by the DE4 amendment. Representative Garande explained that the bill, originally intended to codify Integrated Community Supports (ICS), was being redirected because of concerns about fraud vulnerability and program integrity. The DE4 would create a smaller legislative study group to redesign ICS, pause DHS changes for about six months while the group develops a transition plan, continue DHS fraud investigations and enforcement, and ultimately terminate ICS as currently structured. Testimony in support came from Mr. Buck and Zania Harut of the Residential Providers Association of Minnesota, both of whom argued that ICS is unstable, inconsistently implemented, and in need of a new statutory foundation. They said the current system mixes different service models under one rate framework, lacks clear codification, and has shifting policy guidance that creates compliance problems for providers and risks to people receiving services. They emphasized that the bill would preserve oversight and enforcement while allowing time to build a replacement service with clearer rules, documentation standards, and guardrails. Members asked about effects on counties, providers, data, audits, and fraud enforcement. Representative Curran and Mr. Berg said the bill would not change funding structures or DHS’s existing authority to audit, request documentation, investigate fraud, or sanction bad actors, and that the study group would use existing data to identify where problems are concentrated. Vice Chair Gillman supported the study-group approach as a bipartisan, public process and raised concerns about whether the bill would prevent DHS from acting on known fraud; Curran responded that the language was intended to preserve those enforcement actions. The discussion ended without a final vote on the bill in the portion provided, beyond adoption of the DE4 amendment.

Transcript Highlights:

• care provider?
• reproductive health care places providers at risk of being doxxed, harassed, or even killed.
• ' and 'health care.'
• How can abortion, killing a child, be health care? Health care is...
• care, like any other health. care.

Bills: SB41, SB33, SB32, SB30

Keywords: sexual crimes, statute of limitations, criminal justice, victim rights, child abuse, individualized treatment, investigational treatment, health care, life-threatening illness, patient rights, physician recommendation, informed consent, human trafficking, sexual exploitation, child protection, prosecution, crime amendments, SB30, induced abortion, abortion reporting

Transcript Highlights:

• 00:05:14.720> out<00:05:15.199> with<00:05:15.440> reasonable<00:05:15.919> care
• <00:05:16.240> so<00:05:16.479> as carried out with reasonable care so as carried out
• with reasonable care so as to<00:05:16.800> protect<00:05:17.199> any<00:05:17.520>

Bills: SB95, HB322, SB95, HB322

Keywords: underground facilities, excavation safety, One-Call Notification System, utility protection, public safety, underground damage prevention, notification system, construction safety, pipeline protection, utility management, Alabama Municipal Electric Authority, director compensation, municipality, electricity supply, board of directors, postpartum depression, postnatal care, maternal mental health, perinatal depression, postpartum screening

Transcript Highlights:

• I'd like to believe that speaks to the commitment of our health care providers and their recognition
• I'd like to believe that speaks to the commitment of our health care providers and their recognition
• Team-based care is not theoretical in rural health. It is essential.
• care provider who understands what access to care truly means for rural patients and families.
• From a health care perspective, this funding helps ensure continuity of care, protects emergency response

Bills: HB1621, HB1624, HB1623, HB1622, HB1625, HB1626, HB1627, HCR3038

Keywords: presidential physical fitness test, physical education, fitness assessment, student fitness, school curriculum, graduation requirements, elementary school, middle school, high school, public schools, nonpublic schools, superintendent of public instruction, exceptions, disability accommodations, North Dakota studies, computer science, cybersecurity, health education, concept-based fitness class, school standards

Summary: The North Dakota House convened in special session with prayer, roll call, and a quorum present, then took up several rural health-related bills. Senate Bill 2401, as amended, required physicians to complete one hour of continuing education in nutrition and metabolic health each renewal cycle and also added language allowing criminal history background checks for the Board of Occupational Therapy Practice. Supporters emphasized the role of nutrition in reducing chronic disease, and the bill passed 92-0. The House then considered Senate Bill 2402, which expanded pharmacists’ limited prescriptive and therapeutic substitution authority for certain low-acuity conditions and clarified related lab-test and communication requirements. Members discussed examples such as motion sickness, cold sores, lice, hypoglycemia, COVID and flu testing, emergency access to medications and supplies, and limits excluding certain drug classes; the bill passed 91-1. Senate Bill 2403 created a temporary medical facility emergency operating loan option through the Bank of North Dakota for qualifying rural hospitals facing severe financial distress, with extensive debate over the targeted nature of the aid, anti-gifting concerns, repayment terms, and the hospital’s turnaround plan; it passed 80-12. Senate Bill 2404 appropriated funds for NDIT to address federal digital accessibility requirements and for the Public Service Commission’s litigation efforts related to transmission costs, with a backup loan authorization available if needed; it passed 92-0. At the close of the session, leaders thanked members and staff for their work on the rural health transformation package, a committee notified the Governor and the Senate that the House had completed its business, absent members were excused, and the House adjourned sine die.

Transcript Highlights:

• The special session of the Legislative Assembly is convened to act on funding related to the Rural Health
• Act on funding related to the Rural Health Transformation Program.
• transmitted to the second house immediately after second reading, unless the majority or minority leader provides
• After second reading, unless the majority or minority leader provides notice of intent to reconsider.

Bills: HB1621, HB1624, HB1623, HB1622, HB1625, HB1626, HB1627, HCR3038

Keywords: presidential physical fitness test, physical education, fitness assessment, student fitness, school curriculum, graduation requirements, elementary school, middle school, high school, public schools, nonpublic schools, superintendent of public instruction, exceptions, disability accommodations, North Dakota studies, computer science, cybersecurity, health education, concept-based fitness class, school standards

Summary: The North Dakota House convened in special session with prayer, the Pledge of Allegiance, and the reading of communications from the Secretary of State and Governor Kelly Armstrong certifying the special session call. The governor’s executive order said the session was called to act on funding for the Rural Health Transformation Program so the state could accept and appropriate federal funds and avoid interruptions to government services. Three new members, Representatives McNally, Scraw, and Timmons, were sworn in, and the roll showed 91 members present, establishing a quorum. The main business was a Rules Committee report outlining temporary special-session rules. The changes were designed to speed up floor action, including allowing second reading the same day a bill is reported from committee, final passage one day after first reading, and immediate transmission to the other chamber unless reconsideration is noticed. The report also replaced the regular standing committee structure with two joint committees: Joint Appropriations and Joint Policy, allowed remote testimony and remote member participation with approval, and limited bill introduction to Legislative Management-approved bills or bills approved by a two-thirds vote. Several deadline changes for resolutions and bill filing were also described, with some provisions delayed until the special session ends. The House adopted the Rules Committee report after a motion by Representative Bosch and no opposition. During announcements, the clerk listed the membership of the Joint Appropriations and Joint Policy committees, and the Highway Patrol announced safety sessions for legislators in the Rough Rider Room at 11 a.m. that day and the next day. The House then recessed until the joint session scheduled for 10 a.m. the following day.

Transcript Highlights:

• So first, small businesses want to provide health care and health care coverage for their employees.
• Just last month, NFIB released a new health care policy paper that's called Addressing the Health Insurance
• the potential benefit is to providing those coverage to the health care.
• Delayed care and worse health outcomes.
• We're running issues around health care transparency pricing.

Bills: HB138, HB335, HB388, HB138

Keywords: health impact analysis, cost analysis, coverage mandates, health insurance, legislative analysis, health care data, education, funding, classroom resources, teacher support, student outcomes, health benefits, provider dentists, payment reimbursement, insurance code, noncontracting, dental care, reimbursement, health benefit plans, noncontracting providers

Transcript Highlights:

• stakeholders and policy makers on how health care is being utilized, how it's being consumed, and the
• Uh, and administrative cost apply both to the plans and to the physician. and health care providers.
• of benefits questionnaire that will be made available to health care providers.
• We have Texans who, for example, are covered by Medicaid and Medicare. care so this will just provide
• care provider in this great state of Texas.

Bills: HB138, HB335, HB388, HB138

Keywords: health impact analysis, cost analysis, coverage mandates, health insurance, legislative analysis, health care data, education, funding, classroom resources, teacher support, student outcomes, health benefits, provider dentists, payment reimbursement, insurance code, noncontracting, dental care, reimbursement, health benefit plans, noncontracting providers

Transcript Highlights:

• These are businesses that are providing health care to people who have no insurance or anything.
• And if the businesses who are providing that health care are not being paid in a timely manner, I know
• Yeah, but this is really hard to be quiet because the health care providers in the room are all looking
• Currently, the Department of Health Services licenses and monitors health care providers, while AHCCCS
• They are providing care, and I don't want to put more on them. ...providing care, and I don't want to

Bills: SB1095, SB1114, SB1116, SB1162, SB1164, SB1178, SB1179, SB1249, SB1253, SB1346, SB1347, SB1446, SB1561, SB1813

Keywords: gender transition, minors, irreversible surgery, health professionals, puberty-blocking drugs, medical procedures, prohibition, Arizona Revised Statutes, behavioral health, patient brokering, appropriation, state funds, Maricopa County, claims review, medical necessity, American Indian health program, healthcare regulations, healthcare compliance, behavioral health technicians, licensing

Summary: The committee first heard Senate Bill 1114, which would appropriate $1 million to the Maricopa County Attorney’s Office to investigate behavioral health patient brokering statewide. Sponsor Sen. Karen Werner described the bill as a response to fraud involving vulnerable Native Americans and said the county attorney would investigate the whole state. Some members questioned why the Attorney General was not handling the work and whether the funding should go to a county office, while others supported the effort. The committee voted 10-1 with one present to give SB 1114 a due pass recommendation. The committee then considered Senate Bill 1116, which would require that denials or adverse appeal decisions on behavioral health claims for the American Indian Health Program be reviewed by someone with at least two years of relevant clinical experience. Access testified neutral but said the bill’s language was too broad and could increase appeals and staffing needs, estimating about $490,000 for eight FTEs. Sen. Werner said the bill was meant to prevent inappropriate denials by reviewers without relevant expertise. Members raised concerns about definitions and staffing, and the committee approved the bill 7-4 with one present. Senate Bill 1346 would require Access to notify providers of claim deficiencies within 72 hours and decide corrected claims within 10 business days. Supporters said the measure would reduce long delays and help providers stay afloat; Access said it was working on process improvements but warned the bill would require more staff and system changes, estimating about $580,000. The committee passed SB 1346 7-5. Senate Bill 1347, requiring insurance coverage for fertility preservation services for cancer patients at risk of infertility, drew strong support from cancer survivors and advocates, with insurers neutral; the committee passed it unanimously 12-0. The committee also heard Senate Bill 1813, which would require Arizona State Hospital admissions to be based on clinical need rather than county of residence. Supporters argued the Maricopa County cap unfairly delays treatment and is not required by the underlying court ruling, while ADHS warned the bill could conflict with the Arnold v. Sarn settlement and could shift access away from rural counties. After extensive discussion, the committee passed SB 1813 9-2 with one present. Finally, the committee began hearing Senate Bill 1178, which would allow naturopathic physicians to administer IV antibiotics, antivirals, and antifungals; the initial testimony was largely opposed by medical associations on patient-safety and training grounds, with supporters yet to testify in the excerpt provided.

Transcript Highlights:

• This service not only just provide mobility, but it provides empowerment, autonomy.
• The challenges for us are a shortage of foster care providers, gaps in medical and behavioral health
• providers or other providers could grow their business in other ways.
• We've been able to just really provide some wrap-around support and that is what community-based care
• I can tell you within service providers and non nonprofits, the Office of the Governor, the Child Sex

Bills: HB 451, HB 645, HB 1041, HB 1151, HB 1155, HB 1536, HCR 12

Keywords: commercial sexual exploitation, child sex trafficking, human trafficking, child welfare, foster care, DFPS, Department of Family and Protective Services, juvenile probation, risk assessment, needs assessment, trauma screening, child abuse prevention, exploitation screening, validated screening tool, evidence-informed tool, conservatorship, juvenile justice, at-risk youth, trafficking prevention, Child Sex Trafficking Prevention Unit

Transcript Highlights:

• House Bill 3552 will give child care providers the flexibility to bridge the gap between subsidy reimbursement
• House Bill 3886 provides the case of an immediate jeopardy determined by the Department of Health with
• providers.
• Highest rated child care providers.
• You know, she's been in the health department, she's been in a people business, she cares passionately

Bills: HB3131, HB3380, HB3502, HB3552, HB3849, HB3886, HB3907, HB4201, HB4302, HB3448, HB3409, HB4095, HB3637

Keywords: homelessness, shelter standards, safety, accountability, state funding, local governance, regulation, Oklahoma Homeless Shelter Safety and Accountability Act, foster care, child welfare, Department of Human Services, educational opportunities, employment support, technology in child welfare, faith-based organizations, self-sufficiency, financial literacy, HB3502, Oklahoma, children's code

Transcript Highlights:

• health information is safe. ...affirming care provider and ensures that protected health information
• health care information by ensuring that if a health care provider knows or has reason to believe a
• However, it is confusing for health care providers. Let's go on.
• It's simply allowing health care providers... It happens in New Mexico.
• It protects those individuals providing essential health care, and it ensures that private health care

Bills: HB195, HB279, SB30, HB234, HB292, SB100, SB23, SB221, SB261, SB264

Keywords: medical malpractice, judgments, independent providers, insurance, personal assets, settlements, healthcare, healthcare privacy, electronic medical records, reproductive health, gender-affirming care, data protection, location tracking, confidentiality, SB30, induced abortion, abortion reporting, vital statistics, public health reporting, medical records